Cardiovascular System - BLS/ALS Standards

Question 1

Medical Cardiac Arrest

What are the conditons for a Medical TOR

Answer 1

1. Age >18 years
2. Altered LOA
3. Arrest not witnessed by EMS AND no ROSC, AND No defibrillation delivered

Question 2

Trauma Cardiac Arrest

What are the condtions for a trauma TOR?

Answer 2

1. > 16 years of age
2. Altered LOC
   3.
   NO palpable pulses
   AND no defibrillation delivered,
   AND Monitored HR = 0 OR Monitored HR >0 with closest ED >30min transport time away

Question 3

Neonatal Resuscitation

Treatment

Answer 3

1. Provide warmth, clear airway, dry stimulate and repositon for 30 Seconds
2. If pt does not have a HR of >100bpm, provide positive pressure ventilatioon (BVM) using room air for 30 seconds
3. If the HR is not >60bpm, administer chest compression and PPV (BVM) using 100% O2 for 30 seconds

• Repeat step 3 if pt HR is still not >60bpm
• *If pt HR is >60bpm, proceed back to step 2.

Question 4

ROSC

1. Maintain SpO2 between ….
2. What is the target ETCO2 for a ROSC pt?

Answer 4

1. 94-98%

2. 30-40mmHg

Question 5

Cardiac Ischemia

What are the conditions for administering ASA?

Answer 5

Age: >18yrs
LOA: Unaltered
Other: Able to chew and swallow

Question 6

Cardiac Ischemia

What are the contraindications for administering ASA

Answer 6

Allergy or sensitivity to NSAIDs
If asthmatic, no prior use of ASA
Current active bleeding
CVA or TBI in the previous 24hrs

Question 7

Cardiac Ischemia

What is the 
- Route
- Dose 
- Max # of doses
 for adminsitering ASA

Answer 7

1. PO
2. 160-162 mg
3. 1 dose

Question 8

Cardiac Ischemia

What are the conditions for administering NITRO

Answer 8

Age: >18 years
LOA: Unaltered
HR: 60-159 bpm
SBP: Normotension 
Other: Prior hx of nitro use OR IV access obtained

Question 9

Cardiac Ischemia

What are the contraindications for administering NITRO

Answer 9

Allergy or sensitivity to nitrates

Phosphodiestrase inhibitor use within previous 48hours

SBP drops by 1/3 or more of its inital value after nitro is administered

12-Lead ECG compatible with Right ventricular MI

Question 10

Chest injury Syandard

Question 11

Cardiac Ischemia

What is the treatment for a Non-STEMI patient?

1. Route
2. Dose
3. dosing interval
4. Max # doses

STEMI pt?

1. Dose
2. Max # doses

Answer 11

NSTEMI

1. SL
2. 0.3 or 0.4mg
3. 5 mins
4. 6 doses

STEMI

1. 0.3 OR 0.4 mg
2. 3 doses

Question 12

STEMI Bypass Indications (4)

Answer 12

1. ≥18 years of age.
2. Chest pain or equivalent consistent with cardiac ischemia/myocardial infarction.
3. Time from onset of current episode of pain <12 hours.
4. 12-lead ECG indicates an acute AMI/STEMI*:
   a. At least 2 mm ST-elevation in leads V1-V3 in
   at least two contiguous leads; AND/OR
   b. At least 1 mm ST-elevation in at least two
   other anatomically contiguous leads; OR
   c. 12-lead ECG computer interpretation of
   STEMI and paramedic agrees.

Question 13

STEMI Bypass Contraindications (4)

Answer 13

1. CTAS 1 and the paramedic is unable to secure patient’s airway or ventilate.
2. 12-lead ECG is consistent with a LBBB, ventricular paced rhythm, or any other STEMI imitator.
3. Transport to a PCI centre ≥60 minutes from patient contact.**
4. The patient is experiencing a complication requiring PCP diversion:**
   a. Moderate to severe respiratory distress or
   use of CPAP.
   b. Hemodynamic instability or symptomatic
   SBP <90 mmHg at any point.
   c. VSA without ROSC.